Individual
MIRANDA KARLEEN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10692 MEDLOCK BRIDGE RD STE 100A, JOHNS CREEK, GA 30097-8497
(404) 446-2496
Mailing address
10692 MEDLOCK BRIDGE RD STE 100A, JOHNS CREEK, GA 30097-8497
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
94687
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/31/2019
Last updated
05/30/2023
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